Posted on April 6, 2017 by cmps
By Robert James Cimasi MHA CMP™
The False Claims Act (FCA) continues to grow in strength as the federal government and relators increase their use of the law to recover billions of dollars from companies that violate the Act’s provisions. Developments in the application and interpretation of the FCA, particularly in regard to the issue of statistical sampling in proving damages, may significantly influence the regulatory risk to healthcare enterprises, in light of the significant volume of recoveries received by the government under this law for healthcare fraud and abuse violations.
In recent months, interpretation of the FCA influenced the outcome of two prominent healthcare fraud and abuse cases: (1) U.S. ex rel. Michaels v. Agape Senior Community (Agape), originating in the U.S. District Court for the District of South Carolina and heard by the U.S. Court of Appeals for the 4th Circuit; and, (2) U.S. ex rel. Ruckh v. Genoa Healthcare Consulting, Inc. (Genoa), in the U.S. District Court for the Middle District of Florida. The cases, both of which explored the utilization of statistical sampling in proving damages under the FCA, leave unclear the standards associated with the admissibility of expert testimony in this context.
This Health Capital Topics
article summarizes the Agape
cases, and discusses the role that statistical sampling may play in future FCA actions. (Read more…)
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Filed under: CMP Program, Ethics, Health Insurance, Risk Management | Tagged: CMP™ Class, false claims act, Robert Cimasi | Leave a comment »